The external, internal and mixed types of dropsy are distinguished. Moreover, the latter is considered the most dangerous. Mixed hydrocephalus involves a decrease in the brain, in which fluid accumulation occurs both in the space of the ventricles and in the subarachnoid. If it is moderate, then the patient has practically no complaints and he can live with her for a very long time. In more serious cases, the manifestations of hydroencephalopathy in adults are as follows:
- Headache. It hardly passes, but in the morning is stronger than in other periods.
- Nausea. Like a headache, it is especially acute in the morning.
- Drowsiness. This symptom indicates that hydrocephalus is accompanied by other neurological disorders.
- Speech disorders, memory problems.
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- Treatment of external dropsy of the brain in adults
- The main services of the clinic of Dr. Zavalishin:
- Outdoor outdoor
- Acute hydrocephalus
- Methods of diagnosis
- Consequences of the disease
- Prevention of disease
- Adult hydrocephalus: symptoms
- Diagnostic Techniques
- clinical picture
This is non-occlusive hydrocephalus substitution. The subarachnoid space is expanded, and fluid is accumulated in it. An adult with such a disease has the following symptoms:
- constant feeling of fatigue;
- nausea, vomiting;
- minor visual impairment;
- double vision in the eyes;
- changes in sexual behavior;
- walking disorders.
If an adult has a trivalentric occlusal hydrocephalus, in which cerebrospinal fluid fills the spaces of the ventricles, he may suffer from:
- increased intracranial pressure;
- nausea, vomiting;
- severe headaches;
- problems with vision, hearing.
A huge number of factors can provoke dropsy of the brain. The disease occurs due to:
- a stroke;
- infectious diseases of the brain and membranes (meningitis, encephalitis, ventriculitis, tuberculosis);
- vascular pathologies, including aneurysm ruptures;
- head injuries and post-traumatic conditions (normotensive hydrocephalus);
- disorders of the development of the nervous system;
- violations of the production, circulation, absorption of cerebrospinal fluid;
- low density of brain matter.
Brain hydrocephalus in an adult is diagnosed by the following methods:
- MRI It helps not only to verify the correctness of the diagnosis, but also to determine its causes.
- CT scan.
- Cisternography. Diagnosis is to determine the type of hydrocephalus.
- Neuropsychological examination.
- X-ray with a contrast agent.
If as a result of one or more of these studies the prognosis is confirmed, the following treatment methods are used:
- Drug therapy. The option is suitable if the hydrocephalus is moderate. An adult patient is prescribed medications that lower intracranial pressure (Lasix, Mannitol), diuretics. During therapy, a gentle therapeutic massage is also used. All this will help to stabilize the condition of an adult patient, but not to cure him, but to achieve a subcompensated stage.
- Brain bypass. It is not carried out in case of chronic hydroencephaly, inflammation, vision problems, but it is effective in asymmetric form. An adult patient is given drainage, in which excess cerebrospinal fluid goes into other spaces of the body. The operation in the vast majority of cases gives a positive result. After some time, an adult fully returns to his normal life. Periodically need a secondary installation of the shunt.
- Endoscopy Effective with mixed, substitution, symmetric hydrocephalus. Endoscopic surgery is performed with micro-instruments. With their help, remove the fluid and the cause, which disrupts its circulation, for example, a tumor.
- Folk remedies. Effective solely to suppress the symptoms that manifest hydrocephalic syndrome. It is recommended to use diuretic herbal decoctions (oregano, bearberry, parsley), juniper berries, alcohol solution of calamus root.
- Diet. In the case of adult hydrocephalus, nutritional rules must be followed in order to improve the exchange of water-salt balance. It is necessary to categorically refuse products that cause fluid to accumulate in the body. This is fresh bread, fatty meat and poultry, smoked meats, sausages, sweets. Instead, you need to eat more fresh vegetables and fruits, cereals. Dishes are best steamed.
The disease can be cured with the timely detection and selection of the correct method of therapy. However, in an adult, this does not always happen so quickly. If hydrocephalus is not treated, the condition will worsen, and the symptoms will progress. As a result, an adult is threatened with complete dementia. In especially severe cases, hydrocephalus leads to death.
To date, the causes of the development of hydrocephalus of the brain in adults are well studied and described, however, the question of the true mechanism of the development of the normotensive type of the disease remains unclear. We describe the main factors that trigger the start of an ailment in adults.
- Symptoms of hydrocephalus often manifest after previous infectious brain diseases, such as: meningitis, encephalitis, parasitic diseases.
- The reason for the increased formation of cerebrospinal fluid is the papilloma of the vascular plexus.
- Often, hydrocephalus develops against a background of benign or malignant neoplasms in the structures of the cranium.
- Symptoms of the disease may appear after acute cerebrovascular accidents: cerebral infarction, hemorrhagic stroke, subarachnoid hemorrhage.
- In many adults, hydrocephalus develops against a background of organic brain damage: alcoholic, toxic, hypertensive encephalopathies.
- Various contact and intracranial injuries, both closed and open, are capable of starting a pathology.
- Common causes of hydrocephalus are abnormalities of the central nervous system, such as Arnold-Chiari malformation, congenital maldevelopment of the cerebrospinal fluid.
The clinical symptoms of the pathology depend on the factors that triggered the disease, the duration of the illness and the level of intracranial pressure. With hydrocephalus that occurs after a traumatic brain injury or subarachnoid hemorrhage, signs may occur during the first week of the disease. In the chronic course of hydrocephalus, they appear and are burdened gradually.
Almost always, the earliest and prevailing symptom of hydrocephalus is the subject’s walking problems. In the initial segment of the disease, a person’s gait becomes uncertain. An excessively slow pace of movement is noticeable. Spontaneous falls during movement are possible.
As the disease develops, walking disorders are aggravated. It is very difficult for a person to budge: it looks as if his legs are “magnetized” to the floor. The patient moves in small steps. His legs are usually widely spaced. His shuffling gait is striking. It freezes in place when cornering. Sometimes when moving, the patient with hydrocephalus stops and freezes in place, because he is not able to perform the next step.
Moreover, if the patient is in a sitting or lying position, he easily imitates a normal walking step, moving on a bicycle. He, while lying or sitting, is able to “draw” intricate symbols with his feet in the air. Sometimes signs of a violation of control over movements in the upper limbs join.
During a neurological examination of the patient, the following symptoms may be identified:
- increased muscle tone of the lower extremities;
- resistance to passive movements of varying degrees;
- involuntary muscle tension in the legs;
- increased segmental reflexes;
- decreased strength in the legs.
Along with the above symptoms, other signs of hydrocephalus in adults also occur, among which – imbalance. This anomaly is manifested by a sensation of instability of the body, which occurs when trying to get up, take a step, turn. Over time, these signs are aggravated: a person loses the ability to stand independently, and in complex forms of hydrocephalus he cannot even sit.
- Many adults with hydrocephalus complain of severe headache. As a rule, cephalgia occurs after waking up in the morning. Other signs join the headache – discomfort and discomfort in the epigastrium. Vomiting is possible, after which the patient with hydrocephalus experiences relief.
- A common symptom of hydrocephalus in adults is a feeling of pressure coming from the inside of the eyes. A person may feel a burning sensation in his eyes or feel as if small grains of sand were poured into them. The dilated vessels of the eyeballs are visually noticeable. In many adults, a decrease in visual acuity is determined. A man describes the appearance of a veil and “fog” before his eyes. Probably the development of atrophy of the optic nerves.
- As the burden of hydrocephalus is aggravated, mental signs arise that differ in their brightness. In adults, there is a lack of motivation for mental, speech, motor activity. There is a state of complete indifference, indifference to the occurring events. The patient may be disoriented in time and not understand where he is. A dulling of the emotional perception of reality is observed. Common abnormalities are productive symptoms, including visual and verbal hallucinations. Manic syndrome may develop, which is characterized by a triad of signs: increased mood, accelerated thinking and speech, motor excitement. In other adults, symptoms of depression predominate: low mood, inhibition of intellectual activity, motor inhibition.
- Poor prognostic signs are excessive drowsiness in the daytime, a malfunction in sleep-wake mode, persistent insomnia. A separate group of patients develop epileptic seizures. The progression of hydrocephalus leads to a significant deterioration in human cognitive functions. Some patients lose the ability to service themselves.
- Often patients already in the early stages of hydrocephalus indicate an increase in their urination. In most adults, most of the daily amount of urine at night is excreted. In the future, patients have an imperative urge to commit an act of urination. Later, people with hydrocephalus cease to be aware of the urge to urinate. At the same time, they have complete indifference to the involuntary urination that occurs in them.
Treatment of external dropsy of the brain in adults
In adult patients, acquired hydrocephalus is often found, which develops either due to any mechanical damage to the head, or as a result of the development of pathological processes. Why does cerebrospinal fluid accumulate outside the cerebral hemispheres? The explanation is simple: brain structures are broken, adhesions on the veins appear, arachnoid villi are destroyed, as a result, the cerebrospinal fluid does not circulate as it should.
If you delve into the question of the causes of a disease such as external dropsy of the brain, several factors can be distinguished:
- infectious diseases (tuberculosis, meningitis, encephalitis);
- post-stroke condition, the development of sepsis, extensive hemorrhage;
- concussion, head injury, or cervical spine;
- malignant tumors that develop in the stem region.
Frequent intoxication of the body leads to the appearance of external hydrocephalus. For example, the abuse of alcoholic beverages, which infect neurons and lead to the death of tissues. The risk group also includes those patients who suffer from metabolic disorders, diabetes mellitus, multiple sclerosis, encephalopathy, atherosclerosis. Another reason that deserves due attention is the irreversible age-related changes that cause the aging of blood vessels and brain tissue.
The main services of the clinic of Dr. Zavalishin:
In the Department of Neurosurgery Clinical Hospital named after Eramishantseva practiced only effective methods of treating external dropsy of the brain. The methods are divided into two large groups: conservative (medication) and surgical (surgical), each of which has its own characteristics and advantages.
Drug treatment is relevant only in the mild stage of the disease. Special drugs accelerate the outflow of fluid from the brain, increase urination, relieve inflammation and swelling, strengthen blood vessels, and normalize the functioning of the cardiovascular system. To combat severe headaches, your doctor may prescribe non-steroidal anti-inflammatory and analgesic drugs.
Common groups of drugs are vascular, neurotropic, venotonic, diuretics. But with an acute disease, they will be ineffective. Mixed hydrocephalus is poorly corrected. In this case, conservative treatment will not relieve the disease, but will only restore or improve the functioning of individual systems and functions of the human body. Often, surgery is indispensable.
If acute external dropsy is diagnosed, in most cases drainage of the ventricles of the brain is prescribed. The main technologies are endoscopy and open surgery.
In the first case, we are talking about manipulations, which are characterized by minimal trauma, a very low risk of complications, and fairly quick postoperative recovery. Methods of endoscopy allow with minor intervention not only to remove excess cerebrospinal fluid, but also to eliminate defects in veins, hematomas, blood clots.
Currently, an open operation is selected only in exceptional cases. Why? It is difficult to imagine an open surgery without craniotomy. And trepanation is always increased risks and a long postoperative recovery period.
Another way to get rid of dropsy of the external type is bypass surgery. Doctors use a system of valves and silicone tubes to remove excess cerebrospinal fluid from the skull. The fluid redirects to other cavities of the body, in particular to the abdominal cavity, right atrium, superior vena cava. According to statistics, the effectiveness of such a technique is 85%.
Is it possible to protect against the occurrence of external hydrocephalus of the brain? This is a very difficult question. But, if you completely abandon bad habits and avoid craniocerebral injuries, there is a high probability that the trouble will bypass you. Another important point is the timely and professional treatment of such serious diseases as encephalitis, polio, meningitis, and other infectious diseases.
Hydrocephalus is a disease in which cerebrospinal fluid accumulates in the head. This is not ordinary water, but cerebrospinal fluid. If dropsy in children is usually congenital, in which the head is enlarged, as can be seen in the photo, in adults it appears as a result of diseases.
Like any other form of hydrocephalus, replacement hydrocephalus has several forms:
- With external replacement hydrocephalus – cerebrospinal fluid accumulates in the subarachnoid cavity, taking the place of a decreased brain volume.
- With internal replacement hydrocephalus – cerebrospinal fluid fills the ventricles of the brain.
- Mixed replacement hydrocephalus is characterized by accumulation of cerebrospinal fluid both inside the brain and outside, under its shells.
External replacement hydrocephalus of the brain in adults is the most common form of the disease, it usually proceeds moderately and does not give any symptoms for a very long time.
This brain pathology has its own classification according to types:
- By origin, the disease is:
- By the nature of the development of the disease is:
- Spicy. This form of pathology is characterized by transience.
- Subacute. With this form, the pathology develops within a few months.
- Chronic The development of this form lasts from six months.
Also, experts still identify a passive form of pathology, which is also called “moderately pronounced.” It is considered the most dangerous, since it does not have any pronounced symptoms. When the patient understands that the disease still exists and is progressing, then hydrocephalus is already at an advanced stage.
The disease can also have a constant course. when there is no decrease in the brain, but an increase in cerebral fluid occurs.
If at the same time the patient feels well, then the treatment is carried out by a conservative method. The patient should constantly be under the supervision of a specialist and undergo examinations.
If the patient has a progression of the disease, then the treatment is radically.
If you do not provide timely intervention, then the patient may become demented, urinary incontinence will occur, severe headaches occur, and the musculoskeletal system is disturbed. It is also worth noting that if you do not conduct treatment, then this can lead to death.
Moderately expressed external hydrocephalus can be a separate disease and a concomitant symptom of other pathologies, such as:
- Brain Injury
- Infectious diseases.
It is also necessary to remember that this pathology can occur in patients as a result of:
- impaired motor function;
- high blood pressure;
- also with atherosclerosis.
This type of hydrocephalus, like any other, develops as a result of the accumulation of cerebral fluid in the cavities of the brain. As a result, the patient has increased pressure inside the skull, there is intense pressure on the brain substance and the space between the arachnoid and soft membranes of the brain decreases.
Moderate external hydrocephalus can be of several types:
- Congenital It develops due to adverse environmental factors in the prenatal period. As a result, the baby has problems with the nervous system, defects are noted. In most cases, the pathology is diagnosed in children who were born prematurely. It has distinct signs that make it clear about the presence of the disease. Prevention includes prenatal diagnosis of increased pressure inside the skull and the elimination of its causes.
- Acquired. It develops as a result of trauma to the brain and inflammatory processes. It also has severe symptoms, leading to certain complications.
This type of hydrocephalus has such main signs:
- nausea and vomiting;
- drowsiness, violation of the vestibular apparatus;
- involuntary urination;
- doubles in the eyes.
The provoking causes of moderate hydrocephalus include:
- Age changes.
- High blood pressure.
- Brain Injury
Open external hydrocephalus of the brain – impaired absorption of cerebral fluid, but at the same time there is free communication between the liquor-bearing spaces
Depending on the root causes that caused hydrocephalus, they distinguish:
- acquired hydrocephalus.
Congenital is a consequence of intrauterine disruption of the central nervous system or developmental defects. Acquired same occurs, as a rule, after FM trauma, inflammation, the appearance of neoplasms, etc.
Birth defects that contribute to the development of hydrocephalus:
- Congenital disorder of the development of the circulatory system of Arnold-Chiari. The disease develops as a result of a violation of the process of decreasing cerebrospinal fluid from the fourth cavity of the GM. It is quite likely manifestation both in combination with a hernia of the spinal cord and its membranes, and without it.
- The primary stricture of a narrow channel connecting the third and fourth cavities of the GM. Regardless of what develops inside the womb, often clinically
pictured external hydrocephalus in adults
diagnosed in adult patients.
Secondary stricture of a narrow channel connecting the third and fourth cavities of the GM. It may result from the mechanism of replacement of damaged neuronal tissues by glia cells as a result of blood loss resulting from intrauterine infection.
Genetic inherited defects:
- genes that are associated with chromosome x are responsible for the development of hydrocephalus;
- congenital impairment of the development of the circulatory system of Dandy Walker.
Acquired defects that contribute to the development of hydrocephalus:
- Caused by infection. It is often diagnosed in the case of communicating hydrocephalus.
- Damage that occurs as a result of subarachnoid hemorrhage.
- Posthemorrhagic. This is the second most common cause of communicating hydrocephalus.
- Damage that occurs after hemorrhage inside the cavities of the GM. According to statistics, 25-48% of patients develop developing hydrocephalus. Without the formation of neoplasms. Tumors, arteriovenous malformations.
- Secondary With extensive processes inside the skull.
- It is accompanied by the formation of neoplasms. The disease is formed as a result of the presence of obstructions of the liquor-bearing directions, which causes neoplasms in the cerebellum of the lateral cavity of the GM.
- After the operation, the following is characteristic. Approximately 20 percent of children who have undergone the extraction of tumors of the posterior cranial fossa feel the need for surgery by implanting shunts.
Hydrocephalus is morphologically recognized, depending on its location with respect to the brain tissue of the enlarged spinal cavities. Celebrate:
- external hydrocephalus in adults.
Depending on the degree of pressure that the cerebrospinal fluid exerts, normo- and hypertensive hydrocephalus is secreted.
From a clinical and functional point of view, there are:
- stabilized hydrocephalus;
From a clinical point of view, the second type of disease is subcompensated or decompensated (it is precisely the purpose of the surgical intervention).
Regressive and stabilized deviations are usually compensated, so surgery is not an urgent need.
In acute hydrocephalus, the symptoms are the result of increased pressure inside the skull:
- Emerging pains in the head – the patient experiences especially severe pains when he wakes up in the morning. This can be explained by the fact that pressure increases during sleep.
- Nausea and vomiting – the manifestation of these symptoms is also characteristic of the morning hours. After cleansing the stomach, pain in the head sometimes subsides.
- Lethargy is one of the most dangerous symptoms, indicating an increase in pressure inside the skull. When it occurs, most likely, the rapid, sharp progress of neurological symptoms is approaching.
- Symptoms of displacement of brain tissue relative to solid brain formations – an early suppression of the patient’s consciousness up to the development of coma, then the patient takes a forced position of the head, oculomotor disturbances occur.
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Signs of hydrocephalus in adults in this case:
- Cognitive impairment – in most cases, symptoms in adults appear after 15-20 days after an injury, a bleeding of blood vessels in GM, meningitis, etc.
- The patient gets confused in the time of day, that is, he feels lethargic in the daytime, and cannot sleep at night. The patient becomes passive, indifferent to what is happening.
- Memory impairment – first of all, the ability to remember numbers is deteriorating. In this case, the patient incorrectly voices the months, numbers and forgets how old he is.
- At the advanced stages of the disease, intellectual abnormalities may occur, as a result of which the patient cannot take care of himself, and may not be able to answer questions at all or answer, spending a lot of time while taking breaks between words.
- Violation of the walking process is a syndrome in which the patient in a lying position easily demonstrates how to move or ride a bicycle, but when he rises, he is not able to move normally, that is, moves, spreading his legs wide, rolling from foot to foot.
- Involuntary urine is not necessarily manifested, and is a late symptom of the disease. Deviations of the fundus, as a rule, are absent.
Patients, on condition of a timely diagnosis, who are undergoing therapy, may well live the rest of their lives without significant complications.
In some cases, speech impairment is observed. There may be problems with the disruption of the shunt or infection during installation, which suggests its reinstallation. In especially complex and neglected cases with hydrocephalus in adults, disability is possible.
The prognosis for this disease depends on the root cause and the time spent on diagnosis and the appointment of appropriate therapy. Some restrictions on further life are possible. In some cases, a manifestation of dysfunction of the speech apparatus is possible.
- a stroke of an ischemic or hemorrhagic nature;
- post-traumatic and chronic hypoxia;
- oncological diseases of the brain;
- intraventricular hemorrhages, the occurrence of which is promoted by aneurysms of cerebral vessels.
- congenital – diagnosis is possible even in the period of intrauterine development;
- acquired – occurs as a result of traumatic brain injuries or inflammation processes that directly affect the brain.
Methods of diagnosis
To make an accurate diagnosis is not enough characteristic neurological symptoms – a brain examination is required. Most often, an MRI is sufficient to detect atrophy of brain tissue and an increase in cerebrospinal fluid volume. However, in some cases, additional examinations are needed.
This is angiography, ultrasound, radiography of the skull, with suspected infectious nature of the disease – tests for the causative agents of herpes, syphilis, toxoplasmosis, as well as ophthalmoscopy.
Replacement hydrocyphaly – empty Turkish saddle
Often replacement hydrocephalus is detected by chance. With a mild course of the disease, it is necessary to undergo an examination at least once every six months in order to identify the first signs of developing disorders in the early stages. If intracranial pressure is sharply increased, then treatment should be started immediately.
If a replacement hydrocephalus was found during a brain examination, there is no reason to hope that it will pass over time.
Like any other form of this disease, it is not prone to independent regression.
The tactics of external replacement hydrocephalus therapy is determined depending on the severity of the symptoms and the nature of the brain lesion. With substitution hydrocephalus, most often a conservative treatment is enough, but its severe forms may require surgical intervention.
When the disease proceeds without pronounced symptoms and is not accompanied by an increase in intracranial pressure, it is sufficiently aimed at improving cerebral circulation and the general condition of the body of therapy.
This is a massage of the collar area and temples, moderate physical activity, therapeutic baths, the use of nootropics and drugs that improve blood supply to the brain, such as Phenibut, Glycine, Cavinton, Cinnarizine, Cerebrolysin.
If intracranial pressure is elevated, diuretics are prescribed for the patient to remove excess fluid from the body and reduce the volume of cerebrospinal fluid: Diacarb, Furosemide, Mannitol.
If there is such a need, diuretics in tablets can be replaced with herbal remedies with a similar effect – these are poplar buds, corn stigmas, nettles. With the regular use of diuretics, it is imperative to use potassium and magnesium preparations, as well as foods rich in these trace elements, such as bananas, nuts, legumes, lettuce, spinach and dark chocolate, since they are excreted in large quantities in urine.
Surgery for replacement hydrocephalus is extremely rare, but in cases where the disease begins to progress sharply, leading to a serious deterioration in the patient’s condition in a short time, it may be necessary.
Most often, with internal hydrocephalus, a shunt is installed that connects the ventricular cavity to any other body cavity, starting with the pericardium and ending with one of the ureters.
This is usually an abdominal cavity. When a certain indicator of intracranial pressure is reached, the shunt valve opens and excess fluid leaves the brain.
This operation removes all the symptoms of the disease, but the healthy life of a patient with a shunt depends on the condition of the device, which from time to time needs to be replaced.
Endoscopic surgeries, such as endoscopic ventriculostomy, in which holes are made for ventricular outflow in the ventricular fundus, are devoid of this drawback, but they are far from being carried out in all clinics.
Since each case of hydrocephalus is individual, a universal treatment regimen does not exist, and for each particular patient, their own options for the most effective fight against the disease are selected.
Among the most effective studies in diagnosing dropsy of the brain, computed tomography (CT) and magnetic resonance imaging (MRI) are distinguished. These methods help to determine the shapes and sizes of the ventricles, brain cisterns and subarachnoid space.
To determine the direction of cerebrospinal fluid flow and clarify the type of disease, radiography of the cisterns of the brain base is used.
In some cases, a trial lumbar puncture may be prescribed, as a result of which about 50 milliliters of fluid is excreted, which contributes to a temporary improvement in the condition. This is due to the fact that there is a restoration of blood supply to ischemic tissues against a background of reduced pressure. This is a fairly favorable prognosis for surgical treatment.
The main role in establishing a diagnosis belongs to computed tomography (CT) and magnetic resonance imaging (MRI). These methods allow you to determine the shape and size of the ventricles, subarachnoid space, brain cisterns.
X-ray analysis of the cisterns of the base of the brain allows us to evaluate the direction of cerebrospinal fluid flow and to clarify the type of hydrocephalus.
It is possible to conduct a test diagnostic lumbar puncture with the withdrawal of 30-50 ml of cerebrospinal fluid, which is accompanied by a temporary improvement. This is due to the restoration of blood supply to ischemic brain tissue amid decreased intracranial pressure. This serves as a favorable prognostic sign in predicting surgical treatment of hydrocephalus.
The initial stages of hydrocephalus can be treated with medication. For this, the following drugs are used:
- to reduce intracranial pressure and remove excess fluid (provided that cerebrospinal fluid outflow is preserved) – diacarb (acetazolamide), mannitol and mannitol in combination with furosemide or lasix. Mandatory with this treatment is the correction of the level of potassium in the body, for this use aspartame (panangin);
- Cavinton (vinpocetine), actovegin (solcoseryl), gliatilin, choline, cortexin, cerebrolysin, semax, memoplant, etc. are shown to improve brain tissue nutrition.
Clinically developed hydrocephalus is subject to surgical treatment, medical methods improve the condition for a short time.
Acute hydrocephalus, as a life-threatening condition, requires immediate neurosurgical treatment. It consists in trepanation of the skull and the application of external drains, providing the outflow of excess fluid. This is called external ventricular drainage. In addition, through the drainage system, it is possible to administer drugs that dilute blood clots (since intraventricular hemorrhage is one of the most common causes of acute hydrocephalus).
Chronic hydrocephalus requires liquor rescue operations. This type of surgical treatment is the withdrawal of excess cerebrospinal fluid into the natural cavities of the human body using a complex system of catheters and valves (abdominal cavity, pelvic cavity, atrium, etc.): ventriculoperitoneal, ventriculoatrial, cystoperitoneal bypass.
To date, the less traumatic neuroendoscopic technique has come first among invasive treatments. It is still more often carried out abroad due to the high cost of the operation itself. This method is called as follows: endoscopic ventriculocysternostomy of the bottom of the third ventricle. The operation lasts only 20 minutes.
With this method of treatment, a surgical instrument with a neuroendoscope (camera) at the end is inserted into the ventricles of the brain. The camera allows you to demonstrate the image using a projector and precisely control all the manipulations. At the bottom of the third ventricle, an additional hole is created that connects to the tanks of the base of the brain, which eliminates the cause of hydrocephalus. Thus, the physiological cerebrospinal fluid between the ventricles and tanks is restored.
It has long been known that just a thorough examination of the patient and a competent collection of anamnesis allow the doctor to make an accurate diagnosis with almost one hundred percent certainty.
When evaluating complaints of a dropsy patient, an experienced specialist will easily suspect he has hydrocephalic syndrome. Additional research methods will only be used to identify the extent of the disaster.
Correctly performed with hydrocephalus diagnostics allows the doctor to determine the treatment methods. This is especially important for acute dropsy of the brain. Diagnostic error can lead to serious consequences of hydrocephalus and even lead to death of the patient.
For more detailed information about the severity of the patient’s condition, you can apply:
- MRI scan;
- CT diagnostics;
- ultrasound examination (ultrasound) of the neck and head to assess the state of blood vessels;
- magnetic resonance imaging (MRI) helps to identify changes in the soft tissues and determine the type of hydrocephalus, the stage of development of the pathology as accurately as possible;
- computed tomography (CT) is designed to determine the degree of damage to brain tissue, the size of subarachnoid cracks, the presence of neoplasms;
- an x-ray with the introduction of a contrast agent is aimed at identifying violations in the outflow of venous blood and damage to the vascular bed;
- spinal puncture is prescribed if there is a suspicion of the development of dropsy after encephalitis or meningitis and you need to find out what level of cerebrospinal fluid pressure;
- Ophthalmologic examination – the ability to determine whether the patient has swelling of the optic nerve and atrophy of the tissues of the ocular apparatus.
IMPORTANT! If the diagnosis of “chronic external hydrocephalus of the brain” has been confirmed, an additional diagnostic examination is preferably carried out after 6 months. The intensity of further visits to the doctor depends on the data received and is determined individually.
Consequences of the disease
Hydrocephalus is a dangerous disease, ignoring the symptoms of which is fraught with disability or even a threat to life. The fact is that the changes that occur in the brain as a result of the prolonged existence of hydrocephalus are irreversible.
Untimely treatment can turn into a tragedy for a person: disability and social significance. Mental disorders, problems with movement, impaired urination, decreased vision, hearing, epileptic seizures – this is the list of possible consequences of hydrocephalus if treatment is not started in a timely manner. Therefore, at the slightest suspicion of hydrocephalus, it is necessary to seek qualified medical help.
TVC, program “Doctors” on the theme “Hydrocephalus”
TVC – Hydrocephalus – Farhat F.A.
- Neoplasms in the GM. Neoplasms located in the stem part of the GM and in the cavities of the GM have a strong effect on the movement of matter.
- Inflammatory processes and damage to the body by such diseases as: meningitis, encephalitis, tuberculosis, etc.
- Bleeding of vessels inside the skull. Important points are subarachnoid and intracavitary bleeding, which are most closely associated with hydrocephalus.
- Circulatory disorders in GM, for the most part, of an acute nature: hemorrhagic and ischemic strokes.
- Encephalopathies that have different sources of occurrence: alcohol, as a result of prolonged oxygen starvation, etc.
To avoid hydrocephalus, it is recommended to adhere to the recommendations of a specialist and pay attention to preventive methods:
- Timely treatment of infections and inflammatory processes.
- Refusal to drink alcohol.
- Prevention of atherosclerosis and hypertension.
- The correct way of life, an active lifestyle.
- Proper and balanced nutrition.
- A thorough and regular examination after receiving brain injuries.
- A visit to a specialist at the first manifestation of the disease.
If the patient undergoes a timely examination and hydrocephalus is detected at the initial stage, then there is a high probability of recovery.
External replacement hydrocephalus is a common brain pathology that can provoke irreversible consequences. It can be treated; surgery is required to get a positive result. It has certain symptoms, but only at the middle and late stages of development.
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Prevention of disease
Preventive measures that prevent the development of substitution hydrocephalus are not diverse.
Infections should be avoided, which in the long run can lead to damage to the nervous tissue, traumatic brain injuries, and with symptoms of increased intracranial and arterial pressure, timely measures should be taken, as well as the abuse of alcohol and other neurotoxic substances.
To prevent the main reason for the development of the disease – age-related changes in the brain – is currently impossible.
In conclusion, it should be said that replacement hydrocephalus rarely proceeds in a severe form and usually responds well to therapy. Therefore, when making this diagnosis, one should not despair and imagine the worst.
Sometimes hydrocephalus does not manifest itself in any way and the diagnosis is detected by chance. Moderate brain hydrocephalus in adults is often perceived as the initial symptoms of dementia, but these are two completely different diseases.
Alternative methods of treating a brain tumor are described in this article.
Adult hydrocephalus: symptoms
Dropsy of the brain or hydrocephalus is a disease that affects not only small children, but also adults. It is very dangerous and can lead to extremely serious consequences. It will be useful for you to know what specific symptoms hydrocephalus has and what are the methods of treating the disease.
The disease in children differs significantly from the manifestations of the disease in the adult population due to the fact that the brain is still being formed in the children’s body. This article will discuss the causes, symptoms, and treatment of adult hydrocephalus.
Each person in the brain has special spaces containing a special liquid – cerebrospinal fluid. Inside the brain itself is the system of the ventricles of the brain communicating with each other, outside the brain is the subarachnoid space with the tanks of the brain. Liquor performs very important functions: it protects the brain from strokes, shocks and infectious agents (the latter due to the antibodies contained in it), nourishes the brain, participates in the regulation of blood circulation in the confined space of the brain and skull, and provides homeostasis due to optimal intracranial pressure.
The volume of cerebrospinal fluid in an adult is 120-150 ml, it is updated several times a day. The production of cerebrospinal fluid occurs in the vascular plexuses of the ventricles of the brain. From the lateral ventricles of the brain (containing approximately 25 ml), cerebrospinal fluid enters through the Monroe opening into the third ventricle, the volume of which is 5 ml.
From the third ventricle, the cerebrospinal fluid moves into the fourth (also contains 5 ml) along the Silviev water supply (brain water supply). At the bottom of the fourth ventricle there are openings: a median unpaired Magandie and two lateral Lyushka. Through these openings, cerebrospinal fluid enters the subarachnoid space of the brain (located between the soft and arachnoid membranes of the brain).
Absorption (resorption) of cerebrospinal fluid occurs in the venous system of the brain through arachnoid cells and villi. The accumulation of villi around venous sinuses is called pachyon granulation. Part of the cerebrospinal fluid is absorbed into the lymphatic system at the level of the nerve membranes.
Thus, the cerebrospinal fluid produced in the vascular plexuses inside the brain is washed from all sides and then absorbed into the venous system, this process is continuous. So the circulation is normal, the amount of fluid produced per day is equal to the absorbed. If at any stage there are “problems” – either with products or with absorption, then hydrocephalus arises.
The causes of hydrocephalus can be:
- infectious diseases of the brain and its membranes – meningitis. encephalitis, ventriculitis;
- brain tumors of the stem or periostemal localization, as well as the ventricles of the brain);
- cerebral vascular pathology, including subarachnoid and intraventricular hemorrhages as a result of rupture of aneurysms, arteriovenous malformations;
- encephalopathies (alcoholic, toxic, etc.);
- brain injuries and post-traumatic conditions;
- malformations of the nervous system (for example, Dandy-Walker syndrome, Sylvian aqueduct stenosis).
Hydrocephalus can be congenital and acquired. Congenital, as a rule, manifests itself in childhood.
Depending on the development mechanism, there are:
- closed (occlusal, non-communicating) hydrocephalus – when the cause is a violation of cerebrospinal fluid flow due to the closure (block) of cerebrospinal fluid paths. More often than not, the normal flow of cerebrospinal fluid is prevented by a blood clot (due to intraventricular hemorrhage), part of the tumor or adhesion;
- open (communicating, disresorptive) hydrocephalus – based on impaired absorption into the venous system of the brain at the level of arachnoid villi, cells, pachyon granulation, venous sinuses;
- hypersecretory hydrocephalus – with excessive production of cerebrospinal fluid by the vascular plexuses of the ventricles;
- external (mixed, ex vacuo) hydrocephalus – when the cerebrospinal fluid content is increased both in the ventricles of the brain and in the subarachnoid space. In recent years, this form has ceased to be classified as hydrocephalus, since the reason for the increase in cerebrospinal fluid content is atrophy of the brain tissue and a decrease in the brain itself, and not a disturbance in the circulation of cerebrospinal fluid.
Depending on the level of intracranial pressure, hydrocephalus can be:
- hypertensive – with increasing pressure of the cerebrospinal fluid;
- normotensive – at normal pressure;
- antihypertensive – with reduced cerebrospinal fluid pressure.
According to the time of occurrence, there are:
- acute hydrocephalus – the development period of the process is up to 3 days;
- subacute progressive – develops within a month (some authors consider a period of 21 days);
- chronic – from 3 weeks to 6 months and above.
The clinical picture depends on the period of hydrocephalus formation and the level of cerebrospinal fluid pressure, the development mechanism.
In acute and subacute occlusal hydrocephalus, a person complains of a headache more pronounced in the morning (especially after sleep), accompanied by nausea and sometimes vomiting, which bring relief. There is a feeling of pressure on the eyeballs from the inside, there is a burning sensation, “sand” in the eyes, the pain is bursting. Possible injection of scleral vessels.
As the cerebrospinal fluid pressure increases, drowsiness joins, which serves as a poor prognostic sign, as it indicates an increase in symptoms and threatens loss of consciousness. It may impair vision, a feeling of “fog” before the eyes. Congestion of the optic nerves is detected on the fundus. If the patient does not seek medical help on time, the continued increase in cerebrospinal fluid and intracranial pressure will lead to the development of a dislocation syndrome – a life-threatening condition.
It manifests itself as a rapid suppression of consciousness up to a coma, paresis of an upward gaze, divergent squint, oppression of reflexes. These symptoms are characteristic of compression of the midbrain. When compression of the medulla oblongata occurs, symptoms of swallowing disorders appear, the voice changes (until unconscious), and then cardiac activity and breathing are inhibited, which leads to the death of the patient.
Chronic hydrocephalus is often associated with normal or slightly increased intracranial pressure. It develops gradually, months after the causative factor. At first, the cyclical nature of sleep is disturbed, or insomnia, or drowsiness appears. Memory worsens, lethargy and fatigue appear.
The second typical symptom of chronic hydrocephalus is walking disorder. At first, the gait changes – it becomes slow, unstable. Then the uncertainty when standing, the difficulty in starting the movement, joins. When lying or sitting, the patient can imitate walking, cycling, but in an upright position, this ability is instantly lost.
The gait becomes “magnetic” – the patient is as if glued to the floor, and, having budged, takes small shuffling steps on his legs wide apart, marking time. These changes are called “walking apraxia.” Muscle tone increases, in advanced cases, muscle strength decreases, and paresis in the legs appears. Balance disorders also tend to progress, up to the inability to stand or sit on their own.
Often patients with chronic hydrocephalus complain of frequent urination, especially at night. Gradually urge to urinate, requiring immediate emptying, and then even urinary incontinence.
The outcome of this ailment is dangerous, because if you are late with the start of therapy, the consequences can be irreparable.
Stable pressure, as a rule, causes disruption of the GM and deformation of the skull. Dementia is often the result of this disease.
Not so rarely does a fatal outcome occur, which is why it poses a great danger to human health.
As already mentioned, brain hydrocephalus in an adult is a dangerous disease. which can affect the basic functions of the brain and cause death.
Therefore, the timely correct conclusion of the doctor and the beginning of therapy can serve as a speedy recovery and return to your normal life. But it is worth remembering that taking medications is ineffective, so you should not refuse operations, if this is really necessary.
Depending on the mechanism of the onset of the disease, three types of hydrocephalus in adults are determined:
- Closed (not communicating). This form of the disease is related to the disorganization of the outflow of cerebrospinal fluid due to the closure of the paths of decrease. The cause of such a violation, as a rule, is a neoplasm or blood clot that remains after the inflammatory process.
- Communicating or open form. In this case, the root cause is considered to be malfunctions in the processes of cerebrospinal fluid absorption in the venous system, as certain structures are violated.
- Hypersecretory form. This is a form of the disease that produces more cerebrospinal fluid than necessary, i.e. its excess.
Indeed, at an early age, congenital hydrocephalus leads to head deformity due to sharply increased intracranial pressure. Replacement hydrocephalus, however, is completely different.
Firstly, it is usually found in elderly patients, and secondly, since the sutures of an adult’s skull are ossified, the disease does not lead to its increase and deformation.
Thirdly, it may be accompanied by normal or even decreased intracranial pressure. Therefore, very often the disease remains undetected for many years or even decades.
Brain replacement hydrocephalus: symptoms and treatment is the topic of this article.
- the stage of development of the disease;
- age category of the patient;
- cerebrospinal fluid pressure level and many others.
To make the correct diagnosis, you need to do a whole range of procedures:
- Computed tomography is a fairly accurate diagnosis of the contours of the GM, its cavities and skull. It is carried out to establish the shape and size of the cavities, to determine deviations – various neoplasms.
- Magnetic resonance – MRI makes it possible to establish the severity and type of disease. These studies are necessary to accurately establish the causes of dropsy.
- Radiography of the tanks of the base of the skull – used to establish the type of disease and determine the path of decrease of the cerebrospinal flu >
MRI for hydrocephalus in adults photo
At the initial stage, pathology in most cases cannot be diagnosed independently, since there is no pronounced symptomatology. This condition is called a mild disease. If the degree of damage to this organ is not strong, then the body will try to recover on its own and normalize the circulation of cerebral fluid.
The mild degree has positive prognoses, is treatable, and has practically no consequences.
If the pathology began to progress, then the patient will have severe symptoms, increased pressure on the brain. In such a situation, if you do not contact a specialist for timely help, then the lack of treatment can lead to negative consequences, up to death.
Depending on the type of hydrocephalus of the brain in adults, the clinic of its manifestations will change. Similar symptoms can progress at different speeds, which will directly affect the outcome of the disease.
Symptoms common to any hydrocephalus can be divided into an syndrome of increased intracranial pressure, or hypertensive hydrocephalic syndrome, and a symptom complex associated with compression of the brain.
As a rule, this is a mild hydrocephalus. It is considered the easiest form. Symptoms increase gradually, without sudden jumps. Most often occurs as a chronic pathology. A factor in the development of this disease is a past meningeal infection.
A characteristic group of signs accompanying hydrocephalic syndrome, which grows gradually and in the early stages is almost invisible:
- Memory impairment
- Sleep cycle disorder.
- Indifference to what is happening, apathy.
- Vomiting of central origin.
- A growing headache, a feeling of fullness in the head, a feeling of pressure on the eyeballs.
- Drowsiness, weakness, yawning, dizziness.
- Mental disorder in the form of nervous conditions.
- Tachycardia, sweating, fainting conditions are in the late stages of hydrocephalus due to the lack of timely treatment.
In addition to PVPD syndrome, there are neurological manifestations associated with incipient compression of the brain and an excess of cerebrospinal fluid:
- Visual impairment.
- Disorder of coordination of movements (cerebellar ataxia).
- Paresis and paralysis.
- The loss of all types of sensitivity.
- Muscle hyperreflexia.
- Emotional instability, aggressive, asocial behavior.
In general, a chronically developing dropsy of the brain has such manifestations as:
- Increasing dementia, i.e., decreased intelligence.
- Disorders of motor function – lower paraparesis.
- Impaired urination
It is considered a serious violation of cerebrospinal fluid circulation. Most often, it proceeds sharply, accompanied by symptoms of increased intracranial pressure and compression of brain structures of a pronounced nature. Possible loss of consciousness up to coma, loss of vision, impaired activity of the cardiovascular and respiratory systems.
Here are just some of the acute symptoms of hydrocephalus in adults:
- a sharp unbearable headache that does not respond to painkillers;
- severe nausea and vomiting, which does not bring relief;
- signs of a dislocation of brain structures, manifested by various cerebral disorders;
- violation of behavior and psyche;
- decrease and loss of sensitivity;
- pronounced weakness – a poor prognostic sign, indicating an increase in symptoms;
- blurred vision.
Moderate hydrocephalus of the brain with timely treatment costs a minimum of consequences. The prognosis for life is favorable.
In cases where the disease is started, the patient may develop serious intellectual and mnestic disorders. He cannot take care of himself; he is losing socialization skills.
With acute hydrocephalic syndrome, especially in cases where adequate therapy has not been carried out, brain compression that occurs with hydrocephalus can lead to serious consequences.
One of the formidable complications of hydrocephalic syndrome is swelling of brain tissue. Due to the limited volume of the cranial cavity, its structures are displaced relative to each other and the bones of the skull, resulting in compression of the cerebral hemispheres, cerebellum and medulla oblongata, where vital centers are located. All this leads to their ischemia and a serious violation of the functions of the central nervous system, which cause characteristic signs of hydrocephalus.
Serious consequences arising from hydrocephalus can be avoided with timely diagnosis and correctly prescribed treatment.
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